头颈部结节性筋膜炎21例临床分析

Nodular fasciitis of head and neck:Clinical analysis of 21 cases

目的:分析头颈部结节性筋膜炎(nodular fasciitis,NF)的临床表现、影像学特点、病理学特征、鉴别诊断要点及其治疗与预后。方法:回顾性分析苏北人民医院2010—2020年间21例头颈部NF的临床资料、影像学检查结果和病理学检查结果。结果:头颈部NF常表现为短期迅速增大的皮下或黏膜下实性肿物,颈部多发;影像学表现缺乏鉴别特征;病理学检查可见大量增生的梭形细胞,呈漩涡状排列且胞质染为淡红色,伴红细胞外渗,向周围肌肉内生长,没有异常核分裂象;免疫组织化学结果显示,波形蛋白(vimentin)、平滑肌肌动蛋白(smooth muscle actin,SMA)和肌肉特异性肌动蛋白(muscle-specific actin,MSA)呈阳性表达,desmin、肌酸激酶(creatine kinase,CK)、上皮膜抗原(epithelial membrane antigen,EMA)、CD34、S100呈阴性表达。术后随访6个月,21例患者均无复发。结论:头颈部NF的组织学特征与身体其他部位的NF相似,但头颈部NF的肌肉组织受累频率更高。仅凭临床表现及术前影像学检查难以确诊NF,切除术后行病理学检查是该病的最佳诊断方法。口腔颌面外科医生应提高对该病的认识,避免误诊及过度治疗。

Objective:To investigate the clinical manifestation,imaging characteristics,pathological features,key points of differential diagnosis,treatment and prognosis of nodular fasciitis(NF)of head and neck.Methods:A total of 21 cases of NF of head and neck with clinical manifestation,imaging examination results and pathological results from Subei People′s Hospital between 2010 and 2020 were retrospectively analyzed.Results:The NF of the head and neck was usually presented as rapidly increased subcutaneous or submucosal solid masses in a short term,characterized as more lesion occurrences in the neck;imaging manifestations lacked distinguishing features;the pathological examination showed hyperplasic spindle cells were in swirling arrangement with cytoplasmic pale red staining and erythrocyte exosmosis,and grew into the surrounding muscle,without abnormal mitotic figures;immunohistochemical results showed positive for smooth muscle actin(SMA),vimentin and(muscle-specific actin,MSA),but negative for desmin,creatine kinase(CK),epithelial membrane antigen(EMA),CD34 and S100.After 6-month follow-up,there was no recurrence in 21 cases.Conclusions:The histological characteristics of NF of head and neck are similar to those of other parts of the body,but the muscle tissue is more frequently involved in NF of neck and head.It is difficult to diagnose the disease only by clinical manifestations and preoperative imaging examination.Pathological examination after resection is the best diagnostic method.Oral and maxillofacial surgeons should enhance the awareness of the disease to avoid misdiagnosis and overtreatment.